PT  - JOURNAL ARTICLE
AU  - Kang, Kaijiang
AU  - Gong, Peipei
AU  - Gao, Feng
AU  - Mo, Dapeng
AU  - Zhao, Xingquan
AU  - Miao, Zhongrong
AU  - Ma, Ning
TI  - Predictors and Outcomes of Periprocedural Intracranial Hemorrhage after Stenting for Symptomatic Intracranial Atherosclerotic Stenosis
AID  - 10.3174/ajnr.A8379
DP  - 2024 Oct 10
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2024/10/10/ajnr.A8379.short
4100  - http://www.ajnr.org/content/early/2024/10/10/ajnr.A8379.full
AB  - BACKGROUND AND PURPOSE: Periprocedural intracranial hemorrhage is one of common complications after stent placement for symptomatic intracranial atherosclerotic stenosis. This study was conducted to demonstrate predictors and long-term outcomes of periprocedural intracranial hemorrhage after stent placement for symptomatic intracranial atherosclerotic stenosis.MATERIALS AND METHODS: We retrospectively analyzed patients with symptomatic intracranial atherosclerotic stenosis stent placement in a prospective cohort at a high-volume stroke center. Clinical, radiologic, and periprocedural characteristics and long-term outcomes were reviewed. Periprocedural intracranial hemorrhage was classified as procedure-related hemorrhage (PRH) and non-procedure-related hemorrhage (NPRH). The long-term outcomes were compared between patients with PRH and NPRH, and the predictors of NPRH were explored.RESULTS: Among 1849 patients, 24 (1.3%) had periprocedural intracranial hemorrhage, including PRH (4) and NPRH (20). The postprocedural 30-day mRS was 0−2 in 9 (37.5%) cases, 3−5 in 5 (20.8%) cases, and 6 in 10 (41.7%) cases. For the 14 survivors, the long-term (median of 78 months) mRS were 0−2 in 10 (76.9%) cases and 3−5 in 3 (23.1%) cases. The proportion of poor long-term outcomes (mRS ≥3) in patients with NPRH was significantly higher than those with PRH (68.4% versus 0%, P = .024). Anterior circulation (P = .002), high preprocedural stenosis rate (P < .001), and cerebral infarction within 30 days (P = .006) were independent predictors of NPRH after stent placement.CONCLUSIONS: Patients with NPRH had worse outcomes than those with PRH after stent placement for symptomatic ICAS. Anterior circulation, severe preprocedural stenosis, and recent infarction are independent predictors of NPRH.CASSISSChina Angioplasty & Stenting for Symptomatic Intracranial Severe Stenosis StudyICASintracranial atherosclerotic stenosisNPRHnon-procedure-related hemorrhagePRHprocedure-related hemorrhageSAMMPRISStenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial StenosisVISSITVitesse Intracranial Stent Study for Ischemic Therapy